Factors involved in maintaining prolonged functional independence following supratentorial glioblastoma resection

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  • Department of Neurosurgery, Johns Hopkins School of Medicine; and Neuro-Oncology Surgical Outcomes Research Laboratory, Baltimore, Maryland
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Object

The median survival duration for patients with glioblastoma is approximately 12 months. Maximizing quality of life (QOL) for patients with glioblastoma is a priority. An important, yet understudied, QOL component is functional independence. The aims of this study were to evaluate functional outcomes over time for patients with glioblastoma, as well as identify factors associated with prolonged functional independence.

Methods

All patients who underwent first-time resection of either a primary (de novo) or secondary (prior lower grade glioma) glioblastoma at a single institution from 1996 to 2006 were retrospectively reviewed. Patients with a Karnofsky Performance Scale (KPS) score ≥ 80 were included. Kaplan-Meier, log-rank, and multivariate proportional hazards regression analyses were used to identify associations (p < 0.05) with functional independence (KPS score ≥ 60) following glioblastoma resection.

Results

The median follow-up duration time was 10 months (interquartile range [IQR] 5.6–17.0 months). A patient's preoperative (p = 0.02) and immediate postoperative (within 2 months) functional status was associated with prolonged survival (p < 0.0001). Of the 544 patients in this series, 302 (56%) lost their functional independence at a median of 10 months (IQR 6–16 months). Factors independently associated with prolonged functional independence were: preoperative KPS score ≥ 90 (p = 0.004), preoperative seizures (p = 0.002), primary glioblastoma (p < 0.0001), gross-total resection (p < 0.0001), and temozolomide chemotherapy (p < 0.0001). Factors independently associated with decreased functional independence were: older age (p < 0.0001), coexistent coronary artery disease (p = 0.009), and incurring a new postoperative motor deficit (p = 0.009). Furthermore, a decline in functional status was independently associated with tumor recurrence (p = 0.01).

Conclusions

The identification and consideration of these factors associated with prolonged functional outcome (preoperative KPS score ≥ 90, seizures, primary glioblastoma, gross-total resection, temozolomide) and decreased functional outcome (older age, coronary artery disease, new postoperative motor deficit) may help guide treatment strategies aimed at improving QOL for patients with glioblastoma.

Abbreviations used in this paper:

BCNU = 1,3-bis-(2-chloroethyl)-1-nitrosourea; CAD = coronary artery disease; CCNU = 1-(2-chloroethyl)-3-cyclohexyl-nitrosourea; GTR = gross-total resection; IQR = interquartile range; KPS = Karnofsky Performance Scale; QOL = quality of life; RPA = recursive partitioning analysis; RR = relative risk; STR = subtotal resection.

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Contributor Notes

Address correspondence to: Alfredo Quiñones-Hinojosa, M.D., The Johns Hopkins Hospital, Department of Neurosurgery, Johns Hopkins University, CRB II, 1550 Orleans Street, Room 247, Baltimore, Maryland 21231. email: aquinon2@jhmi.edu.

Please include this information when citing this paper: published online June 4, 2010; DOI: 10.3171/2010.4.JNS091340.

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